Rwanda Health Conference Booklet 2006 by Laura Clauson

WELCOME TO A Public Forum and Roundtable Discussion of an Upper Valley Initiative in Rwanda

REACHING OUT TO CENTRAL AFRICA: A RURAL HEALTH CLINIC PROJECT Saturday May 20, 2006 9:00am – 4:00pm Richard W. Black Recreation Center 36 South Park Street, Hanover, NH

Forum Objectives To raise awareness of the health situation in Rwanda. To introduce the CCHIPS project in Bisate, Rwanda and encour age local enthusiasm and support. To familiarize local health care professionals with the opportunity for visiting Rwanda and transferring their skills to help build hu man capacity.

Population: 9 Million (Rwanda is the most densely populated country in Africa) Size: slightly smaller than Maryland Life expectancy at birth: total population: 46.96 years Religions: Roman Catholic 56.5%, Protestant 26%, Adventist 11.1%, Muslim 4.6%, indigenous beliefs 0.1%, none 1.7% (2001) Languages: Kinyarwanda (official) universal Bantu vernacular, French (official), English (official), Kiswahili (Swahili) used in commercial centers Chief of state: President Paul KAGAME (since 22 April 2000)

AGENDA WELCOME

Muffins and Coffee 9:00

INTRODUCTION

Mrs. Wyman, Donor

9:30

Dr. Felix Kayigamba

9:45

Dr. Alecia Lilly

10:45

11:30

KEYNOTE SPEAKERS Ruhengeri Hospital Ecosystem Health

PROSPECTIVE PARTNERS Seldon Labortories International Mental Health

Heidi Luquer

Dr. Matthew J. Friedman Dr. Kathleen Allden

12:00

Laura Clauson, Director

12:30

THE PROJECT CCHIPS

PLEASE JOIN US FOR A RWANDAN LUNCH

ROUNDTABLE DISCUSSION, Q&A

2:30

Rwandan Ministry of Health

Ruhengeri Hospital

Dr. Felix Kayigamba, Director Dr. Kayigamba was born in Uganda in 1974. In 1995, he returned to Rwanda to attend medical school at the National University of Rwanda. He worked for 2 years in the Ruhengeri Hospital before he was made Director in October, 2005. Dr. Kayigamba was one of 4 doctors when he became the director.

It is a testament to his ingenuity and dedication that there are now 15 doctors working in his hospital and great strides have been made in the quality of service and employee motivation. With at least 3 days a week without electricity, 40% of patients not being able to pay, and severe lack of equipment and trained personal, Dr. Kayigamba has become well trained in crisis management. He is finishing his Masters in Public Health at the National Univer sity of Rwanda. Dr. Kayigamba is married and has a 3 year old son.

Ruhengeri Hospital is the main referral hospital in the north of Rwandan. It has 250 beds and 80% of patients live in rural areas. Greatest Need: Qualified Staff and Equipment Specialist doctors: need 15; have 8 (2 gynecologists, 1 surgeon, 1 anesthesiologist, 2 pediatricians, 2 internal medicine General doctor: need 30; have 7 A1 Nurse (3 year college degree): need 60; have 20 A2 Nurse (finished high school): need 30; have 63 A3 Nurse (don’t finish high school): need 0; have 5 Other workers: need 0; have 70 (not allowed to fire them)

Does Not Exist: Ophthalmology, Ears, Nose & Throat, Mental Health

None of the departments have sufficient equipment.

KINYABABA Kinyababa Ñ

KAGOGO

CYANIKAÑ

Gitare

BUTARO

Butaro Ñ

NYANGE

KINIGI Bisate

MUSANZE

MUHOZA

BUSOGO

Kabatwa

BUSASAMANA Ñ usasamana MUDENDE Ñ

KANZENZE

RUBAVU Ñ

ÑBigogwe

TSIRO Ñ

unu

MUZO

Mataba

RUSHASHI Ñ

MINAZI

Nyange

Coko Ñ

COKO

SOVU Rutsiro

MUSASA GIHANGO

Kabona Ñ

RUSEBEYA

Ntobwe Ñ

BWIRA

NDARO Ñ

Ruli MUHONDO

P RULI Æ Ñ

Muhororo

GATUMBA KABACUZI RUGENDABARIÑ Ñ

Rubona

MUKURA

Mukura Ñ

Mushishiro Ñ

MUSHISHIRO

KAYENZI

Kayenzi

NGAM

Karanga Ñ

Ruko

MUHANGA

Ñ P Æ

Buramba

Mushubati MUSHUBATI

Muhondo

EZA MANIHIRA

Maternal Mortality: 1071/100,000 (WHO acceptable level 400) Ñ

NGORORERO

Musasa

MUYONGWE

Rwankuba

BireheÑ

NGORORERO Gitega

Kageyo

BUSH

Rushashi

MATABA

Ramba KIBANGU KAVUMU Ñ Ñ Nyabikenke Infant Mortality: 118/1000 (WHO acceptable level 50) Rususa KAGEYO Ñ MURUNDA Ñ KIYUMBA Learn more: www.moh.gov.rw Ntaganzwa Ñ Murunda MUHORORO Gasovu Ñ P Æ

RUHANGOKarumbi

SHONYI

Muramba

OUEST

NOR

Rusoro

Greatest Health Issues

Rubaya

Tare

Ñ HIV/Aids: 13.2% Kigali, 6.3% Urban, 3.1% Rural Ñ NYABINONI KABAYA Leading cause of death in adults HINDIRO Hindiro Dr. Felix started treating HIV/Aids in August 2004. RONGI Ñ MUHANDA 1400 people are on treatment, 1100 are on Nyange prophylaxes against opportunistic infections. Ñ

inihira

Biruyi

GASHENYI Rutenderi KARAMBO Ñ BASE

NembaÆ Ñ P

CYUN

Karambo

NEMBA

JOMBA Malaria: Accounts for 40% of visits to a hospital or health center MURINGA Kabaya Nyabinoni P Æ Ñ Ñ Leading cause of death in under 5s MATYAZO

NYABIRASI

Nyamugali

NEMBA Ñ

BUSENGO

Gakamba

mbiri GEYO

KAMUBUGA Ñ CYABINGO KIVURUGA

RUH

KANAMA Ñ

Nyakiliba

KARAGO Mwiyanike

Nyabirasi

Kivumu

Cyabingo

KINTOBO MUKAMIRA

NYUNDO

Bushoka

Gatonde Rurembo Dr. Kayigamba’s catchment area is 400,000 RUREMBO GAKENKERukura NYABIHU Rambura Shyira Janja JANJA GAKENKE people, but increases to 1 million when people P Æ RAMBURA Birembo come from other areas lacking in services. SHYIRA GATONDE Jomba

Karambo

Murandi

Busengo

Arusha

NYAKILIBA GERERO Nyundo

RUGERA RUSASA There are 11 health centers (N) in his area: Bisate, Kinigi, Casiza, Shingiro, Busogo, Kabere, Ñ Ñ Nyakigezi BIGOGWENyakinama, Ruhengeri Urban Dispensary, Muhoza, Rwaza, Murandi.

Kabari

Nyakinama

NZARWE

Kirambo

RWERERE

NKOTSI RWAZA

Rwankeli

KIVUYE

Mucaca

Kora

Mudende

JENDA

RUSARABUGE GASHAKI Ñ ÑREMERA RUGENGABARI

Rwaza

KabereMUKO

Busogo

GITOVU

GACACA

Rusasa

P Muhoza Æ

GATARAGA Kareba

KINONI

CYUVE Karwasa

KIMONYI KABATWA

CYERU BURERA

Ntaruka

MUSANZE

BUGESHI

Gasiza

SHINGIRO Shingiro Ñ

RUGARAMA

Kinoni

GAHUNGA

Kinigi

KARAMA KAYUMBU

P Æ

RUKOM

Kab

Rutobwe Ñ

Kamony KAMO

GACURABWEN Ñ MUSAMBIRA CYEZA

Dian Fossey Gorilla Fund

Ecosystem Health Programs

Dr. Alecia Lilly, Regional Director The War On Worms — 67,000 People Treated Amoeba and worms are among the most ubiquitous pathogens in humid, rural environments. They are easily identified under a mi croscope, and easily and inexpensively treated. Worms and amoeba lead to years of malnutrition When 9599% people are infested with of people tested are worms, it is difficult for their infected with worms immune systems to fight off other pathogens.

The goal is to assess, treat, and provide prevention education against intestinal parasites. People are also most interested in re ceiving a program that demonstrates how to prevent reinfestation. Our prevention seminars teach that Conservation, for DFGF, means working toward achieving a healthy ecosystem for both people and gorillas.

The program is explained to the villagers and fecal samples are taken.

$1,000,000 worth of medicine donated by Pfizer

The Ecosystem health program goes to the villages, regardless of how remote or inaccessible they are. A lab tech carries medicine to a village with no road ← Prevention posters are left in the villages. The liter acy rate is low; the message must be graphic. →

A Program to bring a healthy environment to endangered animals within parks and reserves and to the people who live around them . Dr. Lilly teaches lab assistants how to analyze samples _______________________________________________________________________________ Alecia Lilly, Ph.D., is Director of the Dian Fossey Gorilla Fund’s Conservation Action Program. Dr. Lilly started the Ecosystem Health Program in Southwest Central African Republic in 1999. She collected data on the Ba’Aka which had higher intestinal parasite prevalences than the other ethnic groups. The Ba’Aka are the poorest ethnic group in that region, have more traditional meth ods of hygiene, and rarely receive medical treatment. She was told that the Ba’Aka would not want to be tested and would not be able to figure out how to take the medication. Expecting to analyze 150 people, she was amazed to discover over 1,000 willing participants standing in the hot central African sun for hours waiting for an appointment. In 2001, Dian Fossey Gorilla Fund offered an opportunity to export the Ecosystem Health Program to Rwanda and the Democratic Republic of Congo.

Learn more: www.gorillafund.org

Comprehensive Community Health Initiatives & Programs (CCHIPS)

Laura Clauson, Director

Photo by Dr. Alecia Lilly

The CCHIPS initiative has been founded to implement a pilot pri mary health care project at the Bisate health centre to assist Rwanda in the achievement of its Health Sector Strategic Plan (HSSP). CCHIPS has been developed to provide integrated, com munitysupported primary healthcare services that are site specific and address Health Sector Program Objectives. Project activities will build upon a preexisting collaboration be tween the Dian Fossey Gorilla Fund (DFGF) and the Ministry of Health (MOH) of Rwanda. This established collaboration pro vides resources support to local health centers by increasing pro ductivity and reducing morbidity through assessment and treat ment of intestinal parasites, hygiene education and positive be havioral change promotion in communities. Under the umbrella of DFGF and in alignment and support of the MOH, CCHIPS will provide the leadership and funding for the initial pilot project. CCHIPS role will be the coordination and im plementation of new and existing primary healthcare (PHC) pro grams and services at the pilot health centre.

Upgrade Infrastructure & Equipment Water, Power, Sanitation: Bisate does not have power. It does not have water. Water is collected from swamps in the forest. There is no waste disposal sys tem. Waste is buried. The latrines are full.

↑ Bisate Health Center’s Women’s Ward

Equipment: The Rwandan MoH has guidelines for the minimum standards expected in a health center. 31% of cen ters currently meet these standards.

Increase Human Resources Capacity Through Training The human resources of NGOs already working in Rwanda with effective train ing modules will be utilized via a col laborative and integrated approach. Local Health Animators (1 per 10 houses) will receive further training in collaboration with Ruhengeri Hospital Visiting health professionals from the United States will provide some training and transfer of skills. ↑ CCHIPS’ First Collaboration: Dr. Lilly inspects the microscope which will be used to expand her Ecosystem Health program by training a lab assistant to identify intestinal parasites.

Promote Community Participation in Improving Health The promotion of community responsi bility and most particularly the encour agement of female participation and leadership in the development of the healthcare system must be strengthened and sustained. The success of the national health policy depends on community mobilization and participation. ← Bisate Primary School has 1700 children.

Some of Bisate’s Needs The way it is...

The way it should be...

1 mattress $20 1 bed cover $7

3500 liter rain water tank $1166

Security fence $8000

Solar power between $3,000— $30,000

Sanitary toilets $5000 Incinerator $1500

Even a little bit makes a difference. Malaria is the biggest killer of children under 5. A mosquito net costs $5. 1 year of health insurance for a family …….……$6.00 1 consultation at a health center …………...……$0.33 1 month salary for a nurse …………………..... $50.00 1 month salary for a doctor …………………..$254.00

“If you think you are too small to be effective, you have never been in bed with a mosquito”

Betty Reese

DONATIONS CCHIPS is fiscally sponsored by the Dian Fossey Gorilla Fund. DFGFI is a nonprofit 501C(3) corporation. All contributions are tax deductible. Please make checks payable to: DFGFICCHIPS

Seldon Laboratories

Global Water Solution: Pure Water Saving Lives Heidi Luquer Seldon has developed an exciting new technology that reliably removes micro organisms from fluids, without the use of heat, ultraviolet radiation, chemi cals, contact time, or significant pressure. Provides reliably clean water, free of bacteria and virus Effective against all microorganisms in water Does not require high pressure Environmentally benign Simple to operate and requires little maintenance The product takes advantage of the most recent advances in nanotechnology to create a "kill zone" capable of destroying all shapes and all types of bacteria and virus, as well as other pathogenic microbes such as the common Crypto sporidium parvum and Giardia lamblia. Independent testing at the EPAcertified Water Treatment Technology Assis tance Center at the University of New Hampshire has confirmed that the tech nology is an absolute barrier against passage of microbial contaminants. Testing has shown a greater than log 4 reduction in waterborne virus and a greater than log 6 reduction in bacteria. These reduction levels meet or exceed EPA standards for drinking water. Learn more: www.seldontechnologies.com

International Mental Health “The impact of intense violence on survivors is enormous. Their basic psychological needs are profoundly frustrated—their iden tity, their way of understanding the world, and their spirituality disrupted. These disruptions, along with those of interpersonal relationships, and the ability to regulate internal emotional states, coexist with and give rise to intense trauma symptoms” (Staub, Pearlman, Gubin, Hagengimana, 2005) Rwanda has one visiting psychiatrist and one mental health hospi tal. There is a great need for the kind of assistance that psycholo gists and other mental health professionals can provide. Many people are looking for help, especially in April during the Geno cide memorials. CCHIPS is exploring ways to bring a mental health model to the north. ▫▫▫▫▫▫▫ Matthew J. Friedman, Ph.D., MD, is Executive Director of the VA’s Na tional Center for PTSD and Professor of Psychiatry and Pharmacology at Dart mouth Medical School. He has worked with PTSD patients as a clinician and researcher for twenty years. Dr. Friedman is past president of the International Society for Traumatic Stress Studies and has been a member of the VA’s Per sian Gulf Expert Scientific Committee since 1993. Kathleen Allden is Assistant Professor of Psychiatry at Dartmouth Medical School and Lecturer in the Department of Social Medicine at Harvard Medical School. She also is the Medical Director of the International Survivors Center in Boston, a program that offers mental health, legal and social services to refugees, asylum seekers and victims of torture and human rights abuses. All den works with the International Rescue Committee to develop training initia tives in international mental health and psychosocial humanitarian assistance for refugee and waraffected communities in Africa, Asia and elsewhere. Her expertise involves crosscultural psychiatric assessment and mental health care of highly traumatized refugees, asylum seekers and survivors of war, mass violence, torture and other forms of extreme humanrights abuse. Allden has worked in refugee camps and makeshift hospitals, evaluating and treating hun dreds of victims of torture and mass violence. Learn more: www.ncptsd.va.gov

Selected Readings on Global Health The Rwandan Ministry of Health has a well written and thought out Health Sector Policy and Health Sector Strategic Plan . They can be found online at www.moh.gov.rw/publication.html. There are numerous philosophies and books on global health. Following are a selected few: Betrayal of Trust: The Collapse of Global Public Health by Laurie Garrett What do Russia, Zaire, Los Angeles, andmost likelyyour community have in common? Each is woefully unprepared to deal with a major epidemic, whether it's caused by bioterrorism or by new or reemerging diseases resistant to antibiotics. After the publication of her critically acclaimed The Coming Plague, which looked at the reemergence of infectious diseases, Laurie Garrett decided to turn her highly honed reportorial skills to what she saw as the only solutionnot medical technology, but public health. However, what she found in her travels was the collapse of publichealth systems around the world, no comfort to a species purportedly sitting on a powder keg of disease. In Be trayal of Trust, Garrett exposes the shocking weaknesses in our medical sys tem and the ramifications of a world suddenly much smaller, yet still far apart when it comes to wealth and attention to health. The End of Poverty : Economic Possibilities for Our Time by Jeffrey Sachs Celebrated economist Jeffrey Sachs has a plan to eliminate extreme poverty around the world by 2025. If you think that is too ambitious or wildly unrealis tic, you need to read this book. His focus is on the one billion poorest individu als around the world who are caught in a poverty trap of disease, physical iso lation, environmental stress, political instability, and lack of access to capital, technology, medicine, and education. The goal is to help these people reach the first rung on the "ladder of economic development" so they can rise above mere subsistence level and achieve some control over their economic futures and their lives. To do this, Sachs proposes nine specific steps, which he ex plains in great detail in The End of Poverty. Though his plan certainly requires the help of rich nations, the financial assistance Sachs calls for is surprisingly modestmore than is now provided, but within the bounds of what has been promised in the past.

Millions Saved: Proven Successes In Global Health by Ruth Levine, Molly Kinder Seventeen stories about how efforts to improve health in developing countries saved millions of lives and millions of dollars. From polio in Latin America, to measles in southern Africa, to HIV in Thailand, these inspiring case studies show what it takes for global health programs to succeed. One of the greatest human accomplishments has been the spectacular improve ment in health since 1950. In developing countries, life expectancy has risen from 40 to 65 years, and the chances that a child will survive to the age of five has doubled. In addition to directly improving people's lives, this progress con tributes to economic growth. While some of the improvements in health is the result of overall social and economic gains, about half of it is due to specific efforts to address major causes of disease and disability such as providing better and more accessible health services, introducing new medicines and other health technologies, and fostering healthier behaviors. Pathologies of Power: Health, Human Rights, and the New War on the Poor by Paul Farmer Pathologies of Power uses harrowing stories of lifeand deathin extreme situations to interrogate our understanding of human rights. Paul Farmer, a physician and anthropologist with twenty years of experience working in Haiti, Peru, and Russia, argues that promoting the social and economic rights of the world's poor is the most important human rights struggle of our times. With passionate eyewitness accounts from the prisons of Russia and the beleaguered villages of Haiti and Chiapas, this book links the lived experience of individual victims to a broader analysis of structural violence. Farmer challenges conven tional thinking within human rights circles and exposes the relationships be tween political and economic injustice on one hand, and the suffering and ill ness of the powerless on the other. Sickness and Wealth : The Corporate Assault on Global Health by Editors Meredith Fort, Mary Ann Mercer, Oscar Gish In this collection of new essays, international scholars and activists examine how official and corporate actors of globalizationincluding multinationals, the IMF and World Bank, the World Trade Organization, and "first world" govern mentshave enacted policies that limit medical access and promote disease and death for many in the poor world. The contributors provide a history of health and "development" strategies; reveal the grim health consequences of these policies throughout the world; and highlight the work of activists and organiza tions currently working for improved global health.

Selected Readings on Rwanda A People Betrayed: The Role of the West in Rwanda's Genocide by Linda Melvern

Melvern examines the reaction of the international community to the geno cide and the influence of various member states upon the attempts of the UN to stop the murder. She also provides an indepth, meticulous account of the UN peacekeeping mission as experienced by the peacekeepers.

Conspiracy to Murder by Linda Melvern

Melvern has had exclusive access to a wealth of fresh sources including an extraordinary collection of documents abandoned by the conspirators when they fled Rwanda and a full confession from the prime minister in the gov ernment that presided over the genocide. This book makes the case for an urgent enquiry into the scandalous behavior of both the US and the UK in a crime that could and should have been prevented. Genocide in Rwanda: Complicity of the Churches? by Editors Carol Rittner, John K. Roth, Wendy Whitworth

Provides a variety of perspectives through which to assess the complex ques tions and issues surrounding the topic, and, even raises some new questions that could provide insight into this historical event. Contributors have tried to face as carefully, sensitively, and honestly as possible some of the questions about the Church and the 1994 genocide in Rwanda.

The Graves Are Not Yet Full: Race, Tribe, and Power in the Heart of Africa by Bill Berkeley

"This is a book about evil." With these words, Berkeley launches into a grip ping exploration of some of the worst African atrocities of the past 20 years. Focusing on several flash points such as the genocide in Rwanda, the politi cal violence in Zaire and South Africa's apartheid killings, he avers that the violence that has permeated these societies is born of the same evil that moti vated Hitler to kill six million Jews: racially and ethnically based tyranny, which, is the result of Western colonization, not "ageold" hatreds.

King Leopold's Ghost by Adam Hochschild

In the 1880s, as the European powers were carving up Africa, King Leopold II of Belgium seized for himself the vast and mostly unexplored territory surrounding the Congo River. Carrying out a genocidal plundering of the Congo, he looted its rubber, brutalized its people, and ultimately slashed its population by ten millionall the while shrewdly cultivating his reputation as a great humanitarian. Heroic efforts to expose these crimes eventually led to the first great human rights movement of the twentieth century.

Land of a Thousand Hills: My Life in Rwanda by Rosamond Halsey Carr, Ann Howard Halsey Rosamond Halsey Carr left her job as a young New York City fashion illustra tor in the 1940s to join her hunterexplorer husband in the Belgian Congo. For the next 50 years she lived an extraordinary life, witnessing the fall of colonial ism, the loss of her friend Dian Fossey, and the relentless clashes between the Hutus and the Tutsis. Although this book includes a poignant insider's account of the events surrounding the horrific 1994 genocide, it also provides a beauti ful portrait of the Rwanda that wasand still is. After being evacuated during the genocide, Carr returned to Rwanda and, at age 82, rebuilt her home from the ground up, intent on opening a home for some 100 orphaned children. Machete Season: The Killers in Rwanda Speak by Jean Hatzfeld In Machete Season, the veteran foreign correspondent Jean Hatzfeld reports on the results of his interviews with nine of the Hutu killers. They were all friends who came from a single region where they helped to kill 50,000 out of their 59,000 Tutsi neighbors, and all of them are now in prison, some awaiting exe cution. It is usually presumed that killers will not tell the truth about their bru tal actions, but Hatzfeld elicited extraordinary testimony from these men about the genocide they had perpetrated. He rightly sees that their account raises as many questions as it answers. Shake Hands with the Devil : The Failure of Humanity in Rwanda by Roméo Dallaire. Awarded Canada's Governor General's Award. As former head of the late 1993 U.N. peacekeeping mission in Rwanda, Cana dian general Dallaire's initial proposal called for 5,000 soldiers to permit or derly elections and the return of the refugees. Nothing like this number was supplied. The failure of the U.N.'s wealthier members to act as the tragedy un folded obliged the author to leave military service to recover from PTSD. Dal laire's argument that Rwandalike situations are fires that can be put out with a small force if caught early enough will certainly draw debate, but the book documents in horrifying detail what happens when no serious effort is made. We Wish to Inform You That Tomorrow We Will be Killed With Our Families: Stories from Rwanda by Philip Gourevitch. Earned numerous awards and honors. "Hutus kill Tutsis, then Tutsis kill Hutus if that's really all there is to it, then no wonder we can't be bothered with it," Philip Gourevitch writes, imagining the response of somebody in a country far from the ethnic strife and mass killings of Rwanda. But the situation is not so simple, and in this complex and wrenching book, he explains why the Rwan dan genocide should not be written off as just another tribal dispute.

Rwandan Voices Left To Tell : Discovering God Amidst the Rwandan Holocaust by Immaculee Ilibagiza Immaculee Ilibagiza grew up in a country she loved, surrounded by a family she cherished. But in 1994 her idyllic world was ripped apart as Rwanda de scended into a bloody genocide. Immaculee’s family was brutally murdered during a killing spree that lasted three months and claimed the lives of nearly a million Rwandans. Incredibly, Immaculee survived the slaughter. For 91 days, she and seven other women huddled silently together in the cramped bathroom of a local pastor while hundreds of machetewielding killers hunted for them. It was during those endless hours of unspeakable terror that Immaculee discov ered the power of prayer, eventually shedding her fear of death and forging a profound and lasting relationship with God. She emerged from her bathroom hideout having discovered the meaning of truly unconditional love—a love so strong she was able seek out and forgive her family’s killers. The triumphant story of this remarkable young woman’s journey through the darkness of geno cide will inspire anyone whose life has been touched by fear, suffering, and loss. This is Immaculee’s first book. Rwanda Means the Universe : A Native's Memoir of Blood and Bloodlines by Louise Mushikiwabo, Jack Kramer Mushikiwabo is a Rwandan working as a translator in Washington when she learns that most of her family back home has been killed in a conspiracy me ticulously planned by the state. First comes shock, then aftershock, three months of it, during which her worst fears are confirmed: The same state appa ratus has duped millions of Rwandans into butchering nearly a million of their neighbors. Years earlier, her brother Lando wrote her a letter she never got until now. Urged on by it, she rummages into their farm childhood, and into family corners alternately dark, loving, and humorous. She searches for stray mementos of the lost, then for their roots. What she finds is that and more hints, roots, of the 1994 crime that killed her family. Her narrative takes the reader on a journey from the days the world and Rwanda discovered each other back to colonial period when pseudoscientific ideas about race put the nation on a highway bound for the 1994 genocide. Seven years of fulltime collaboration by two writersand the faith of family and friendswent into this emotionally charged work. Rwanda Means the Universe is at once a celebration of the lives of the lost and homage to their past, but it’s no comfortable tribute. It’s an expression of dogged hope in the face of modern evil.

Films on Rwanda 100 Days (2001) Josette, a beautiful young Tutsi girl struggles to survive by taking refuge in a church, supposedly protected by the UNO forces. The Hutu Catholic priest betrays Josette's family and only agrees to spare her life if she submits to rape. By the time she is reunited with her boyfriend, neither of them can face the brutal reality of their situation. She is pregnant and bears the priest's child, which she immediately abandons. 100 Days was shot in the beautiful land scape of Kibuye, which was the site of some of the worst atrocities in 1994. Gorillas in the Mist (1988) This film is a portrait of the anthropologist Dian Fossey (played by Sigourney Weaver) who almost single handedly reversed the extinction of the mountain gorillas in Africa. In the process, she draws international attention to their de clining population and brings herself into ruinous confrontation with relentless, impoverished poachers. Director Michael Apted shot on location in Rwanda.

Hotel Rwanda (2004) Don Cheadle plays reallife hero Paul Rusesabagina, a hotel manager in the Rwandan capital of Kigali who in 1994 saved 1,200 Rwandan "guests" from certain death during the genocide. Director Terry George brings formidable social conscience to bear on a true story you won't soon forget.

Shake Hands with the Devil : The Journey of Roméo Dallaire (2004) This film gives historical background on the tribal hatreds that ravished Rwanda, and an accounting of a decade’s worth of healing. But what it gives most richly is Dallaire himself, a man whose soul has been left tattered by the horrors he saw and might have prevented, and whose road to self redemption is the most torturous journey he has ever undertaken.

Shooting Dogs (2005) Based on a true story. An exhausted Catholic priest (Hurt) and a young idealis tic English teacher (Dancy) finds themselves caught in the 1994 Rwandan genocide. They must now choose whether to stay with the thousands of Tutsis about to be massacred or to flee for safety.

Sometimes in April (2005) A frank take on the 1994 slaughter that claimed upwards of 800,000 lives. Its protagonist (the strong Idris Elba) pieces together the past tragedy from the perspective of a decadelater warcrimes tribunal, where his brother is on trial.

Valentina's Nightmare (1997) For 43 days after the slaughter of her village at the infamous church massacre in Nyarubuye, Valentina, a 13yearold Tutsi girl, lay hidden among the corpses of her family and neighbors, her machete wounds festering with infec tion. Miraculously, she would survive to tell her story.

Thank You for Joining Us

If you woke up this morning with more health than illness, you are more blessed than the million who won't survive the week. If you have never experienced the danger of battle, the loneliness of imprisonment, the agony of torture or the pangs of starvation, you are ahead of 20 million people around the world. If you attend a church meeting without fear of harassment, arrest, torture, or death, you are more blessed than almost three billion people in the world. If you have food in your refrigerator, clothes on your back, a roof over your head and a place to sleep, you are richer than 75% of this world. If you have money in the bank, in your wallet, and spare change in a dish someplace, you are among the top 8% of the world's wealthy. If you can hold someone's hand, hug them or even touch them on the shoulder, you are blessed because you can offer God's healing touch. If you can read this message, you are more blessed than over two billion people in the world that cannot read anything at all. You are so blessed in ways you may never even know.